Novel chemical entities affecting neuroblastoma tumor-initiating cells

ABSTRACT

Disclosed are neuroblastoma tumor-initiating cell inhibiting compositions comprising chemical entities capable of affecting neuroblastoma tumor-initiating cells. Pharmaceutical preparations that include these chemical entities are also provided for the treatment of neuroblastoma. These pharmaceutical preparations are suitable for the treatment of humans, and are particularly suited for the treatment of children of 12 years of age or younger having neuroblastoma. The compositions and pharmaceutical preparations posses reduced normal cell cytotoxicity. The compositions and pharmaceutical preparations may be used alone or together with other conventional neuroblastoma preparations as part of a clinical regimen in the treatment and management of neuroblastoma.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application makes reference to the following co-pending U.S. patent application. The application is U.S. App. No. 60/739,337, entitled “Cancer Stem Cells and Uses Thereof,” filed Nov. 23, 2005. The entire disclosure and contents of the above application is hereby incorporated by reference.

BACKGROUND

1. Field of the Invention

The present invention relates to the field of pharmacologically active chemical compositions useful in affecting neuroblastoma tumor-initiating cells, and the use of such compositions in the treatment of neuroblastoma and related conditions.

2. Related Art

Neuroblastoma (NB) is the most common extracranial solid tumor in children, with poor survival rates in children with metastatic disease. NB is estimated to be responsible for about 15% of cancer-related deaths in children (1, 2). The survival rate for metastatic NB is estimated to be less than 30%. In the majority of these cases, conventional cancer therapies have been ineffective.

Little is reported concerning the precise molecular alterations that give rise to NB, its cell of origin, or why NB cells metastasize and become resistant to chemotherapeutic agents. Unfortunately, genetic mutations that contribute to the origin and progression of 98% of NB cases have not been identified.

One identifiable hallmark of NB is the appearance of proliferating cells with characteristics of neural crest-derived sympathetic neuronal precursors (neuroblasts). NB tumors also frequently contain other neural crest cell types, including neuroendocrine and Schwann cells. Moreover, NB appears in tissues that developmentally derive from the neural crest including sympathoadrenal precursors which differentiate into both sympathetic neurons and adrenal chromaffin cells, the paravertebral and preaortic sympathetic ganglia, and the adrenal gland.

The clinical behavior of NB is unique. Tumors that arise in children under one year of age may spontaneously regress by differentiation or apoptosis, even after arising in or metastasizing to liver and skin. In contrast, NB tumors in children over one-year-old often grow aggressively, disseminate to the bone and bone marrow, and are fatal in the vast majority of cases.

Mass screening of infants showed that NB is much more frequent than previously thought. Many of these tumors regress without clinical diagnosis. Regressing or favorable-prognosis tumors have been reported to express high levels of the TrkA/NGF receptor and display phenotypes of differentiated peripheral neural cells, while malignant or unfavorable-prognosis tumors resemble proliferating sympathoadrenal precursors, often expressing TrkB, amplified N-myc, and many genes involved in neural crest development.

The only reported germline NB predisposition gene is Phox2b, which is mutated in many familial cases of NB, and is required for proper differentiation of sympathetic neurons from neural crest precursors (NCPs) (3, 4). In the regressive form of the disease, the transformed precursors ultimately differentiate or die, while in older children, these molecular transformations instead result in a population of persistently proliferating and highly migratory transformed neuroblasts.

The concept of tumor-initiating cells (TIC) (also called tumor or cancer stem cells) postulates that only rare cells in tumors are endowed with tumorigenic potential, and was initially developed to explain why (i) most tumors are comprised of both undifferentiated proliferating progenitors and post mitotic differentiated cells, (ii) only a very small fraction of tumor cells form colonies after plating in vitro, and (iii) large numbers of tumor cells are required to seed the growth of a new tumor in mice (4-10).

Dick et al. and others reported that clonally-derived tumor cells of acute myelogenous leukemia (AML) patients could be physically separated into tumorigenic and non-tumorigenic fractions (11, 12). Brain and breast tumors have also been reported to contain a subpopulation of TICs (13, 14). Thus, in solid tumors, a rare tumor cell population may fuel tumor growth and seed metastasis. This hypothesis has major implications for treating cancer patients. For example, many current therapies kill the bulk of proliferating tumor cells, but these cells may not be intrinsically tumorigenic, and in many cases the TICs may escape the effects of the therapeutic agents, leading to tumor relapse. Thus, it is essential to identify and characterize TICs from various tumors in order to develop and target therapies against this critical cell type.

TICs have also been shown to share phenotypic characteristics with stem cells derived from their tissue of origin. For example, for a given tissue, the tissue stem cells and TICs both (i) self-renew, (ii) express common phenotypic markers, (iii) grow in a similar fashion in response to mitogens, and (iv) yield tissue-appropriate progeny (13, 14). However, whereas tissue stem cells generate mature differentiated cell types, differentiation of TICs is generally arrested at the level of one or more tissue progenitor cells resulting in tumors comprising a hierarchy of progenitors and some differentiated progeny (4).

Many pediatric and adult tissues contain resident stem cells (4). It is currently unknown if TICs originate by transformation of tissue stem cells. Observations have been made that oncogenic mutations commonly affect genes required for normal stem cell renewal and differentiation (4). This may be particularly relevant for children's tumors, since developing tissues contain a higher proportion of tissue stem cells than do adult tissues.

Tumor initiating cells from some solid tissue tumors, such as breast and brain tumors, have been described. However, a tumor initiating cell population from tumor tissue in a patient with neuroblastoma has not been isolated. One reported observation in some infantile forms of NB (called stage 4S) is that large tumors are frequently found in skin (15). It was previously assumed that skin was a preferred metastatic target for NB. However, a population of tumor initiating cells from such solid tumor tissue has not yet been reported.

The above and other observations in the field reveal a continuing medical need continues to exist in the art to determine why and in which cell type NB arises, and why some neuroblastoma tumors spontaneously regress and others are fatal. In addition, new effective drug targets and therapeutics tailored to identifying and treating specific forms and stages of neuroblastoma are needed.

SUMMARY

The above and other long-felt needs in the art are met in the present invention.

Compositions/Pharmaceutical Preparations:

In one aspect, the invention provides compositions comprising novel chemical entities that are capable of affecting neuroblastoma. In some embodiments, these chemical entities may be described as compounds that specifically kill neuroblastoma tumor-initiating cells, or that arrest the growth of neuroblastoma tumor-initiating cells. In other aspects, these chemical entities and compositions containing one or more of them may be described as having specifically cytostatic or cytotoxic activity toward neuroblastoma tumor-initiating cells.

In some embodiments, the anti-neuroblastoma composition may be described as comprising one or more active ingredients comprising:

2.3-Dimethoxy-1.4-naphthoquinone,

Aklavine Hydrochloride,

Amodiaquin dihydrochloride dehydrate;

Amsacrine Hydrochloride;

Azaguanine-8;

beta-peltatin;

Camptothecine (S.+);

CGP-74514A hydrochloride;

Chelerythrine chloride;

Cholestan-3beta.5alpha.6beta-Triol;

Ciclopirox Olamine;

Clofazimine;

Colchicine;

Convallatoxin;

Crassin Acetate;

Crinamine;

Dequalinium analog. C-14 linker;

Dequalinium dichloride;

Digitoxin;

Digoxigenin;

Dihydrogambogic acid;

Dihydroouabain;

Erysolin;

Gambogic acid;

Mechlorethamine;

Meclizine hydrochloride;

MG 624;

Mitoxanthrone Hydrochloride;

Ouabain;

Oxybendazole;

Oxybendazole;

Paclitaxel;

Parthenolide;

Patulin;

Periplocymarin;

Peruvoside;

Primaquine diphosphate;

Quinacrine dihydrochloride;

Sanguinarine chloride; or

Tomatine,

In some embodiments, the chemical entities of the invention may be described as compounds that possess specific cytostatic or cytotoxic activity toward neuroblastoma tumor-initiating cells. In other embodiments, the neuroblastoma-inhibiting composition further comprises ancitabine hydrochloride, doxorubicin hydrochloride, etoposide, vincristine sulfate, or a combination thereof. In yet other embodiments, the neuroblastoma inhibiting composition may be further described as having reduced non-neuroblastoma tumor-initiating cell cytotoxicity.

In some embodiments, the chemical entities may be described as possessing potent anti-neuroblastoma tumor-initiating cell activity, and a reduced cytotoxicity to normal, non-neuroblastoma tumor-initiating cells, relative to conventional neuroblastoma treatment preparations. In some embodiments, the compositions are described as essentially free of non-neuroblastoma tumor cell inhibiting activity.

Methods of Inhibiting Neuroblastoma Tumor initiating Cells/Methods of Treating and/or Inhibiting Neuroblastoma in an Animal

In yet another aspect, the invention provides methods for inhibiting neuroblastoma tumor-initiating cells. In some embodiments, the method comprises administering an effective amount of a composition comprising a neuroblastoma tumor-initiating cell inhibiting ingredient. In some embodiments, the neuroblastoma tumor-initiating cell inhibiting ingredient comprises one or more active ingredients comprising:

2,3-Dimethoxy-1,4-naphthoquinone,

Aklavine Hydrochloride,

Amodiaquin dihydrochloride dehydrate;

Amsacrine Hydrochloride;

Azaguanine-8;

beta-peltatin;

Camptothecine (S.+);

CGP-74514A hydrochloride;

Chelerythrine chloride;

Cholestan-3beta.5alpha.6beta-Triol;

Ciclopirox Olamine;

Clofazimine;

Colchicine;

Convallatoxin;

Crassin Acetate;

Crinamine;

Dequalinium analog. C-14 linker;

Dequalinium dichloride;

Digitoxin;

Digoxigenin;

Dihydrogambogic acid;

Dihydroouabain;

Erysolin;

Gambogic acid;

Mechlorethamine;

Meclizine hydrochloride;

MG 624;

Mitoxanthrone Hydrochloride;

Ouabain;

Oxybendazole;

Oxybendazole;

Paclitaxel;

Parthenolide;

Patulin;

Periplocymarin;

Peruvoside;

Primaquine diphosphate;

Quinacrine dihydrochloride;

Sanguinarine chloride; or

Tomatine.

In some embodiments, the effective amount of the neuroblastoma tumor initiating cell inhibiting ingredient is an amount effective to arrest the growth of and/or kill neuroblastoma tumor-initiating cells, or effective to induce differentiation of said cells to cell types that no longer proliferate. In other embodiments, the method may further comprise administering a composition further comprising ancitabine hydrochloride, doxorubicin hydrochloride, etoposide, vincristine sulfate, or a combination thereof.

In some embodiments, the composition may further include a pharmaceutically acceptable carrier solution.

In yet other embodiments, the neuroblastoma tumor-inhibiting cells are in an animal having neuroblastoma. In some embodiments, the animal is a human. In some embodiments, the human is 12 years of age or younger. That is, it is anticipated that the invention is particularly useful in the treatment of children afflicted with neuroblastoma, and will have a profound effect on reducing the high rate of mortality in this population of neuroblastoma patients.

The method may be further described as administering a composition that has a reduced non-neuroblastoma tumor-initiating cell cytotoxicity. It is expected that the methods and compositions of the present invention will provide fewer and/or less pronounce undesirable side affect in the treatment of a patient as a result. In some embodiments, the composition employed in the method is essentially free of non-neuroblastoma tumor cell inhibiting activity.

The compositions may be described as comprising a mixture of any or all of the compounds listed below:

TABLE 1 2.3-Dimethoxy-1.4-naphthoquinone AKLAVINE HYDROCHLORIDE Amodiaquin dihydrochloride dihydrate AMSACRINE HYDROCHLORIDE ANCITABINE HYDROCHLORIDE Azaguanine-8 beta-PELTATIN Camptothecine (S.+) CGP-74514A hydrochloride Chelerythrine chloride CHOLESTAN-3beta.5alpha.6beta-TRIOL CICLOPIROX OLAMINE Clofazimine Colchicine CONVALLATOXIN CRASSIN ACETATE CRINAMINE Dequalinium analog. C-14 linker Dequalinium dichloride Digitoxin Digoxigenin Digoxin DIHYDROGAMBOGIC ACID Dihydroouabain ERYSOLIN Etoposide GAMBOGIC ACID Idarubicin MECHLORETHAMINE MECLIZINE HYDROCHLORIDE MG 624 MITOXANTHRONE HYDROCHLORIDE OUABAIN OXYBENDAZOLE Paclitaxel Parthenolide PATULIN PERIPLOCYMARIN PERUVOSIDE Podophyllotoxin Primaquine diphosphate Quinacrine dihydrochloride Sanguinarine chloride TENIPOSIDE TOMATINE Vinblastine sulfate salt Vincristine sulfate

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1, according to one embodiment of the invention, presents a diagrammatic flow chart demonstrating the design of the high throughput, dual-cell (Normal or Tumor cells) screening assay employed in the selection of candidate test compounds that target neuroblastoma tumor-initiating cells. Normal or tumor-initiating cell spheres are dissociated; 3,000 single cells/well are plated in 96 well plates; candidate test compound is added; cell proliferation assayed by Alamar Blue signal. Blue/nonfluorescent compound is converted to a red/fluorescent compound under reducing conditions such as those produced by live cells. The magnitude of the fluorescent signal is proportional to the metabolic activity of the cell sample.

FIG. 2, according to one embodiment of the invention, presents the results from a study wherein FS90 (normal human SKPs, passage 3) cells were treated with the LOPAC library of chemical compounds. Alamar Blue was added after 30 hours and fluorescence intensity read after an additional 24 hours. The hit cutoff is indicated in the graph by the thick line across the graph at the Y axis value of about 69.00% Control Alamar Blue Signal (which corresponds to 3 standard deviations from the mean of all test samples). Nine compounds whose Alamar Blue signals fall below this line were identified as primary hits in this study. (X axis presents the Compound ID number (n=80×8 plates); Y axis presents the % Control Alamar Blue Signal).

FIG. 3A-3C, according to one embodiment of the invention, presents the study results from primary screens of the chemical libraries examined. 3A presents the results of the primary screen in Venn diagram form. The Venn diagrams depict the primary hits from each library. Compounds in the gray-bordered circles (left circle) affected the tumor-initiating cells, while compounds in the black-bordered circles (right circle) affected normal cells. Compounds that affected both cell types lie in the overlap region. Note that there is some compound redundancy between the libraries. 3B presents the confirmed primary hits in Venn diagram form. Primary hits were retested against NB12, FS90 and FS105 (normal human SKPs). 87% of the primary hits were confirmed in this step, yielding 54 unique compounds that target tumor-initiating cells, 4 unique compounds that target normal cells, and 46 compounds that have activity against both normal and tumor cells (overlap region). 3C presents in a pie-format the classification of primary hits by mechanism of action. (Solid light gray area=DNA damaging agents/cell cycle inhibitors; Solid dark gray area=Na+/K+ATPase inhibitors; Diagonal striped area=Neuronal receptor effectors; Vertical striped area=Other; Solid white area=Metabolic inhibitor; Checkerboard area=Neuronal channel effectors; Dotted area=Specific protein effectors).

FIG. 4A-4E, according to one embodiment of the invention, presents the IC50 values that were determined for the 64 selected candidate compounds. Compounds were chosen for further testing based on differential cell type selectivity, mechanism of action, and pharmacological interest. Tumor-initiating cells and normal cells were treated with 10 serial dilutions of compounds (5 μM to 9 nM). Representative graphs are shown in FIG. 4A (Complete Response), 4B (Partial Response), and 4C (Threshold Effect). Compounds that affected the tumor-initiating cells at a much lower dose than normal cells (4D graph, left) or compounds that had a greater effect on the tumor-initiating cells than normal cells (4E, right graph), were selected for secondary in vitro screens in addition to those compounds that only affected tumor-initiating cells. (FS90=normal cells; NB12=tumor-initiating cells).

FIG. 5A-5C, according to one embodiment of the invention, presents the results from secondary screens of the candidate compounds. Compounds of interest are being tested against additional normal primary cultures (FS89, FS105), a stage IV neuroblastoma primary culture (NB25), and a neuroblastoma cell line (KCNR) using a sphere formation assay. 5A presents a flow diagram of the secondary in vitro screen. The candidate compound is added at 0 days and at 3 days. Spheres are counted at 7 days. FIG. 5B presents a dose response curve of various cell lines (FS89, FS90, FS105, NB12, NB25 and KCNR) to amsacrine. FIG. 5C presents a dose response curve of various cell lines (FS89, FS90, FS105, NB12, NB25 and KCNR) to MG624.

FIG. 6A-6FF, according to one embodiment of the invention, presents IC₅₀ values for 32 selected compounds from the LOPAC and Prestwick collections. Tumor-initiating cells (NB12) and normal cells (FS90) were treated with 10 serial dilutions of compounds ranging from 5 μM to 9 nM. Cell survival/growth was assayed using Alamar Blue and the percentage of control Alamar Blue signal was plotted versus log[compound] nM. IC50 values for NB12 are given above each plot.

FIG. 7A-7FF, according to one embodiment of the invention, represents IC50 values determined for 32 selected compounds from the LOPAC, Prestwick, and Spectrum collections. Tumor-initiating cells (NB12) and normal cells (FS90) were treated with 10 serial dilutions of compounds ranging from 5 μM to 9 nM. Cell survival/growth was assayed using Alamar Blue and the percentage of control Alamar Blue signal was plotted versus log[compound] nM (FS90 in dashed line, NB12 in bolded line). IC50 values for NB12 and FS90 are given beside each plot.

DETAILED DESCRIPTION Definitions

Where the definition of terms departs from the commonly used meaning of the term, applicant intends to utilize the definitions provided below, unless specifically indicated.

For the purposes of the present invention, “a”, “an” and “the” include reference to the plural unless the context as herein presented clearly indicates other wise.

For purposes of the present invention, the term “active agent” is defined as a chemical entity, group of chemical entities or compound that is capable of providing an affect on neuroblastoma tumor initiating cells or neuroblastoma cells in vitro or in vivo. The affect of the active agent may be a reduction in cytotoxicity relative to the level of cytotoxicity demonstrated in the absence of the active agent under similar conditions, or a cytostatic affect on neuroblastoma or on neuroblastoma tumor initiating cells that results in a reduced rate of neuroblastoma or neuroblastoma tumor-initiating cell proliferation and/or growth, or a reduction of the rate or occurrence of differentiation into neuroblastoma cell types, precursors, or any other cell type that is related to the progression of a neuroblastoma pathology, or to an increase in the inducement of the differentiation of neuroblastoma tumor-initiating cells into cell types (for example, neurons) that no longer proliferate (for example, retinoic acid is a common differentiation therapy for neuroblastoma that is used as an adjunct therapy after removal of a tumor, differentiation therapy).

For purposes of the present invention, the term “enriched” is defined as containing at least 50% of the identified biological moiety, such as a cancer stem cell.

For purposes of the present invention, the term “neuroblastoma tumor initiating cell” (NB TIC) is defined as a cell that is capable of giving rise to neuroblastoma or a tumor cell that is identifiable with a condition of neuroblastoma, such as a tumor cell that may be identified to have particular identifiable cell surface markers associated with neuroblastoma (such as NB84, CD44, TrkA, GD2, CD34, p75NTR, and/or versican) and/or is without cell surface markers that are characteristic of tumor cells that are not from neuroblastoma (such as CD133, TrkB, and/or CD31).

For purposes of the present invention, the term “neuroblastoma tumor-initiating cell inhibiting activity” is defined as an activity for affecting neuroblastoma tumor-initiating cell survival, proliferation, or that promotes cell differentiation into benign cell types.

For purposes of the present invention, the term, “effective amount” is defined as an amount of a compound that will inhibit and/or reduce neuroblastoma tumor initiating cell survival, proliferation, or that will promote the differentiation of neuroblastoma tumor-initiating cells into benign cell types.

DESCRIPTION Examples Example I Materials and Methods

The present example provides a description of the screening method used to identify the chemical entities capable of affecting neuroblastoma cells reported in the present series of studies.

Malignant neuroblastoma (NB) is the most common extra-cranial solid tumor in children. Survival of patients older than 1 year remains less than 30% with conventional therapies. Candidate NB tumor-initiating cells (TICs) were isolated, and it was hypothesized that TICs are related to SKPs (SKin-derived Precursors). Both SKPs and TICs originate from the neural crest, express similar neural crest markers, and differentiate in vitro into similar cell types. The availability of two neural crest stem cell sources, one from the NB tumor and the other from the skin of the same patient, affords us a unique opportunity for therapeutic target discovery.

Study 1 Screen: Materials and Methods:

To identify compounds that suppress the growth and survival of neuroblastoma (NB) tumor-initiating cells and not nontransformed normal cells (SKPs), a cell-based assay was established and used in which NB tumor-initiating cells from a multiple relapse NB patient (NB12, passage 6-17) and normal SKPs (FS90, passage 2-5) were tested in parallel to detect specific alterations of cell viability/proliferation. For each cell type, cells were passaged 5 days prior to screening. Three thousand (3000) cells in 100□L SKPs growth media (B27, bFGF, EGF, P/S, fungizone in DMEM:F12 with 50% hFS conditioned media) were robotically plated in uncoated 96 well plates and treated with test compound for 30 hours, prior to a 24 hour incubation in the presence of Alamar Blue and subsequent fluorometric reading. Under these conditions, the Alamar Blue signal displayed a linear response with time, background was minimal, and the dynamic range satisfactory (i.e. the Alamar Blue reading at 0 hours vs. 24 hours was >10 fold different).

The robustness of the screen was initially evaluated by using a collection of 1280 bioactive compounds (LOPAC library, Sigma). For both normal SKPs and NB tumor-initiating cells, variability of signals was low, with CV values ranging between 3.5-4.5% across the plates, and the dimensionless, statistical parameters Z′ and Z factors were >0.5, suggesting an excellent assay quality. “Hits” were defined as the compounds whose signals were shifted away by at least 3×standard deviations (99.73% confidence interval) from the mean of the general sample population.

Results:

The screen of the LOPAC library at 5 μM yielded 13 “hits” which were found to affect both normal and NB cells. We also identified 18 compounds that selectively target NB cells. Four compounds selectively targeted normal cells.

TABLE 2 13 compounds that affect both normal and NB cells: Ancitabine hydrochloride Brefeldin A from Penicillium brefeldianum Calmidazolium chloride CGP-74514A hydrochloride Dihydroouabain Diphenyleneiodonium chloride Emetine dihydrochloride hydrate Idarubicin Mitoxantrone Ouabain Quinacrine dihydrochloride Ammonium pyrrolidinedithiocarbamate Sanguinarine chloride

TABLE 3 18 compounds that selectively target NB cells. Loratadine MG 624 Melphalan Podophyllotoxin Ro 25-6981 hydrochloride Rotenone DL-Stearoylcarnitine chloride Taxol Vincristine sulfate Vinblastine sulfate salt Chelerythrine chloride Colchicine Cytosine-1-beta-D-arabinofuranoside hydrochloride Dequalinium dichloride (S)-(+)-Camptothecin Dequalinium analog, C-14 linker 2,3-Dimethoxy-1,4-naphthoquinone Etoposide

TABLE 4 4 compounds selectively target normal cells: 8-Methoxymethyl-3-isobutyl-1-methylxanthine Oligomycin A Sphingosine Thapsigargin

Study 2 Screen: Materials and Methods

The Prestwick library was screened at 5 μM using FS90 and NB12 and at 1 μM using NB12 only due to the high number of “hits” at 5M. This screen identified 9 compounds that selectively target NB12 and 15 compounds that affect both NB12 and FS90.

Results:

TABLE 5 9 compounds that selectively target NB12: Azaguanine-8 Paclitaxel Camptothecine (S.+) Colchicine Etoposide Doxorubicin hydrochloride Lanatoside C Podophyllotoxin Proscillaridin A

TABLE 6 15 compounds that affect both NB12 and FS90: Disulfiram Mitoxantrone dihydrochloride Anisomycin Cephaeline dihydrochloride heptahydrate Digitoxigenin Digoxin Strophantine octahydrate Puromycin dihydrochloride Daunorubicin hydrochloride Emetine dihydrochloride Methyl benzethonium chloride Strophanthidin Cycloheximide Thonzonium bromide Sanguinarine

Study 3 Screen: Methods:

The results from the LOPAC and Prestwick screens were confirmed using FS90, FS105, and NB12. Thirty-six (36) compounds were confirmed that specifically affect NB12 and 29 compounds that affect FS90/105 and NB12. Thirty-two (32) compounds were selected for IC₅₀ determinations using FS90, FS105, and NB12. IC₅₀ for the remaining compounds of interest will be tested at a later date (in combination with hits from additional libraries).

Results:

TABLE 7 36 compounds that specifically affect NB12 (S)-(+)-Camptothecin 2.3-Dimethoxy-1.4-naphthoquinone Ancitabine hydrochloride Antimycin A Azaguanine-8 Benzethonium chloride Camptothecine (S.+) Chelerythrine chloride Ciclopirox ethanolamine Clofazimine Colchicine Colchicine Cycloheximide Cytosine-1-beta-D-arabinofuranoside hydrochloride Dequalinium analog. C-14 linker Dequalinium dichloride Dequalinium dichloride Digoxigenin Diphenyleneiodonium chloride DL-Stearoylcarnitine chloride Doxorubicin hydrochloride Etoposide Etoposide MG 624 Mycophenolic acid Paclitaxel Parthenolide Podophyllotoxin Podophyllotoxin Primaquine diphosphate Quinacrine dihydrochloride Quinacrine dihydrochloride dihydrate Scoulerine Taxol Vinblastine sulfate salt Vincristine sulfate

TABLE 8 29 compounds that affect FS90/105 and NB12 Alexidine dihydrochloride Ammonium pyrrolidinedithiocarbamate Amodiaquin dihydrochloride dihydrate Anisomycin Brefeldin A from Penicillium brefeldianum Calmidazolium chloride Cephaeline dihydrochloride heptahydrate CGP-74514A hydrochloride Daunorubicin hydrochloride Digitoxigenin Digoxin Dihydroouabain Disulfiram Emetine dihydrochloride Emetine dihydrochloride hydrate Idarubicin Lanatoside C Methyl benzethonium chloride Mitoxantrone Mitoxantrone dihydrochloride Ouabain Proscillaridin A Puromycin dihydrochloride Sanguinarine Sanguinarine chloride Strophanthidin Strophantine octahydrate Terfenadine Thonzonium bromide

TABLE 9 32 compounds selected for IC50 determinations using FS90, FS105, and NB12: (S)-(+)-Camptothecin Ammonium pyrrolidinedithiocarbamate Amodiaquin dihydrochloride dihydrate Antimycin A Avermectin B1 Azaguanine-8 Chelerythrine chloride Clofazimine Colchicine Dequalinium analog, C-14 linker Dequalinium dichloride (LOPAC compound) Dequalinium dichloride (Prestwick compound) Digoxin Dihydroouabain Diphenyleneiodonium chloride DL-Stearoylcarnitine chloride Etoposide Idarubicin Loratadine MG 624 Myophenolic Acid Paclitaxel Parthenolide Podophyllotoxin Primaquine diphosphate Quinacrine dihydrochloride Sanguinarine chloride Scoulerine Strophanthidin Terfenadine Vinblastine sulfate salt Vincristine sulfate

Study 4—Screen Results at 5 μM:

The Spectrum collection was screened using the same protocol. At 5 μM, the initial screen identified 35 hits that affect NB12 and FS90, no hits that specifically target FS90, and 41 hits that specifically target NB12. The screen was repeated at 5 μM and 1 μM using NB12 and FS90 to confirm these hits and identified 34 hits that affect NB12 and FS90, no hits that specifically target FS90, and 33 hits that specifically target NB12. Following the Spectrum confirmatory screen, IC₅₀ determinations for an additional 32 compounds were performed.

TABLE 10 34 hits that affect NB12 and FS90: 3-METHYLORSELLINIC ACID 5alpha-CHOLESTAN-3beta-OL-6-ONE 5-AZACYTIDINE AKLAVINE HYDROCHLORIDE CETRIMONIUM BROMIDE CHELIDONINE (+) COLCHICEINE COLCHICINE CYTARABINE DACTINOMYCIN DEOXYSAPPANONE B 7.3′-DIMETHYL ETHER DIGITOXIN DIHYDROGAMBOGIC ACID DISULFIRAM EMETINE GENTIAN VIOLET JUGLONE LANATOSIDE C LYCORINE MITOMYCIN C OXYPHENBUTAZONE PATULIN PERIPLOCYMARIN PERUVOSIDE PHENYLMERCURIC ACETATE PUROMYCIN HYDROCHLORIDE PYRITHIONE ZINC PYRROMYCIN RETUSOQUINONE SANGUINARINE SULFATE SARMENTOGENIN STROPHANTHIDIN THIMEROSAL TOMATINE

TABLE 11 33 hits that specifically target NB12: 10-HYDROXYCAMTOTHECIN 4′-DEMETHYLEPIPODOPHYLLOTOXIN ANDROGRAPHOLIDE AMODIAQUINE DIHYDROCHLORIDE AMSACRINE HYDROCHLORIDE ANCITABINE HYDROCHLORIDE BENZALKONIUM CHLORIDE BENZETHONIUM CHLORIDE BEPRIDIL HYDROCHLORIDE beta-PELTATIN CAMPTOTHECIN CETYLPYRIDINIUM CHLORIDE CHOLESTAN-3beta.5alpha.6beta-TRIOL CICLOPIROX OLAMINE CONVALLATOXIN CRASSIN ACETATE CRINAMINE DIGOXIN ERYSOLIN GAMBOGIC ACID IMIDACLOPRIDE LIMONIN MECHLORETHAMINE MECLIZINE HYDROCHLORIDE OUABAIN OXYBENDAZOLE PACLITAXEL PARAROSANILINE PAMOATE PARTHENOLIDE PODOPHYLLOTOXIN ACETATE STROPHANTHIDINIC ACID LACTONE ACETATE TENIPOSIDE VINBLASTINE SULFATE

TABLE 12 32 Compounds selected for IC50 Determinations: Aklavine hydrochloride AMSACRINE HYDROCHLORIDE ANCITABINE HYDROCHLORIDE ANDROGRAPHOLIDE BEPRIDIL HYDROCHLORIDE beta-PELTATIN CGP-74514A hydrochloride CHOLESTAN-3beta.5alpha.6beta-TRIOL CICLOPIROX OLAMINE CONVALLATOXIN CRASSIN ACETATE CRINAMINE DIHYDROGAMBOGIC ACID ERYSOLIN Gambogic Acid IMIDACLOPRIDE JUGLONE LIMONIN MECHLORETHAMINE MECLIZINE HYDROCHLORIDE Mitomycin C Mitoxantrone hydrochloride OUABAIN OXYBENDAZOLE PARAROSANILINE PAMOATE PERIPLOCYMARIN PERUVOSIDE Prenyletin PYRITHIONE ZINC TENIPOSIDE Tomatidine hydrochloride TOMATINE

These results suggest that patient-specific therapeutics, as well as the molecular and biochemical alterations that lead to neuroblastoma, can be identified using this assay.

Example 2 Identified Compounds that Affect Normal, NB, or NB and Normal Cells

The present example provides a description of the screening method used to identify and select chemical entities capable of affecting (i.e., reducing and/or inhibiting) neuroblastoma cells. The screening method is used here with the LOPAC compound collection. (LOPAC library, Sigma).

Candidate NB tumor-initiating cells (TICs) were isolated. These TICs were used in the screening assay for the identification of these kinds of compounds because they are related to SKPs (SKin-derived Precursors). For example, both SKPs and TICs originate from the neural crest, express similar neural crest markers, and differentiate in vitro into similar cell types. The availability of two neural crest stem cell sources, one from the NB tumor and the other from the skin of the same patient, affords an approach for the therapeutic target discovery provided here.

Materials and Methods: Methods:

To identify compounds that specifically target neuroblastoma TICs, a cell-based assay in which TICs from a NB patient and normal SKPs were tested in parallel. Cells were treated with test compound prior to incubation with a cell viability dye. For both cell sources, signal variability was low and the Z′ and Z factors were >0.5, suggesting excellent assay quality. Hits were defined as compounds whose signals were shifted at least 3 standard deviations from the mean.

Results:

Compounds that Affect NB Cells and Normal Cells

From 3 libraries of compounds, the LOPAC collection, the Prestwick Collection and the Spectrum Collection, 46 compounds were found to affect both normal and NB cells. These 46 compounds are listed in Table 13.

TABLE 13 Normal and Neuroblastoma Hits 3-METHYLORSELLINIC ACID 5alpha-CHOLESTAN-3beta-OL-6-ONE 5-AZACYTIDINE AKLAVINE HYDROCHLORIDE Alexidine dihydrochloride Ammonium pyrrolidinedithiocarbamate Anisomycin Brefeldin A from Penicillium brefeldianum Calmidazolium chloride Cephaeline dihydrochloride heptahydrate CETRIMONIUM BROMIDE CHELIDONINE (+) COLCHICEINE DACTINOMYCIN Daunorubicin hydrochloride DEOXYSAPPANONE B 7.3′-DIMETHYL ETHER Digitoxigenin Digoxin DIHYDROGAMBOGIC ACID Dihydroouabain Disulfiram EMETINE GENTIAN VIOLET JUGLONE LANATOSIDE C LYCORINE Methyl benzethonium chloride MITOMYCIN C Mitoxantrone OXYPHENBUTAZONE PATULIN PERIPLOCYMARIN PERUVOSIDE PHENYLMERCURIC ACETATE Proscillaridin A Puromycin dihydrochloride PYRITHIONE ZINC PYRROMYCIN RETUSOQUINONE Sanguinarine SARMENTOGENIN Strophanthidin Terfenadine THIMEROSAL Thonzonium bromide TOMATINE Table 13: 54 Identified Compounds that Affect NB Cells

Fifty-four (54) compounds selected from the LOPAC collection, Prestwick Collection and the Spectrum Collection, were found to selectively target NB cells. These 56 compounds appear in Table 14.

TABLE 14 Neuroblastoma Specific Hits 10-HYDROXYCAMTOTHECIN 2.3-Dimethoxy-1.4-naphthoquinone 4′-DEMETHYLEPIPODOPHYLLOTOXIN Amodiaquin dihydrochloride dihydrate AMSACRINE HYDROCHLORIDE Ancitabine hydrochloride ANDROGRAPHOLIDE Antimycin A Azaguanine-8 BENZALKONIUM CHLORIDE Benzethonium chloride BEPRIDIL HYDROCHLORIDE beta-PELTATIN Camptothecin (S.+) CETYLPYRIDINIUM CHLORIDE CGP-74514A hydrochloride Chelerythrine chloride CHOLESTAN-3beta.5alpha.6beta-TRIOL Ciclopirox ethanolamine Clofazimine CONVALLATOXIN CRASSIN ACETATE CRINAMINE Cycloheximide Cytosine-1-beta-D-arabinofuranoside hydrochloride Dequalinium analog. C-14 linker Dequalinium dichloride Diphenyleneiodonium chloride DL-Stearoylcarnitine chloride Doxorubicin hydrochloride ERYSOLIN Etoposide GAMBOGIC ACID Idarubicin IMIDACLOPRIDE LIMONIN Loratadine MECHLORETHAMINE MECLIZINE HYDROCHLORIDE MG 624 Mycophenolic acid Ouabain OXYBENDAZOLE Paclitaxel PARAROSANILINE PAMOATE Parthenolide Podophyllotoxin Primaquine diphosphate Quinacrine dihydrochloride Scoulerine Taxol TENIPOSIDE Vinblastine sulfate salt Vincristine sulfate

Four (4) compounds selected from the LOPAC collection, Prestwick Collection and the Spectrum Collection, were found to successfully treat a NB patient and were selected as NB specific hits according to the assay criteria provided herein. These compounds serve as positive controls in the selection and screening methods. These results emphasize the validity of the assay in identifying active agents for treating neuroblastoma. These 4 compounds are listed in Table 15.

TABLE 15 4 Identified Compounds that are used to Treat the NB Patient Patient Hits (i.e. drugs that were used to treat patient AND were selected as NB specific hits) Ancitabine hydrochloride (aka cyclocytidine) Doxorubicin hydrochloride (aka adriamycin) Etoposide Vincristine sulfate

These results suggest that patient-specific therapeutics as well as novel molecular effectors of neuroblastoma can be identified using this assay.

Example 3 Cumulative Screening Assay Selection Results

The present example presents the tabulated data obtained with the various chemical library screens conducted.

TABLE 16 NB hit NB + FS IC50 Library Name Repeated only hit test? target/mechanism S 10-HYDROXYCAMTOTHECIN X X modified camptothecin L 2.3-Dimethoxy-1.4-naphthoquinone X X ROS modulator/Redox cycling agent used to study role of ROS S 3-METHYLORSELLINIC ACID X X Aspergillus terreus fungal metabolite; possible antioxidant S 4′- X X DEMETHYLEPIPODOPHYLLOTOXIN S 5alpha-CHOLESTAN-3beta-OL-6-ONE X X Cholesterol oxidation product; cytotoxic due to oxidative stress or cytoskeleton disruption S 5-AZACYTIDINE X X S ACRIFLAVINIUM intercalating agent that HYDROCHLORIDE interferes with DNA replic/transcription; antitumor, antiproliferative S ACRISORCIN topical anti-infective from 1960s S AKLAVINE HYDROCHLORIDE X X X natural product; anti- infective; related structures have broad activity against NIH tumor lines P Alexidine dihydrochloride X X phospholipase inh; oral gingivitis rinse S ALEXIDINE HYDROCHLORIDE P Alprostadil vasodilator; erectile dysfunction, pallative care for neonatal congenital heart defects L Ammonium pyrrolidinedithiocarbamate X X X blocks NOS mRNA translation P !Amodiaquin dihydrochloride dihydrate X X X antimalarial; treatment of CNS degeneration (Alzheimer, MS) S !AMODIAQUINE X X antimalarial; 4- DIHYDROCHLORIDE aminoquinoline family; narrow therapeutic/toxic window in children S AMSACRINE HYDROCHLORIDE X X X topo II inh; used in AML; may also be active vs malaria L Ancitabine hydrochloride X X cyclocytidine HCl; DNA-synthesis inhibitor (cytosine analog); antileukemic S ANCITABINE HYDROCHLORIDE X X X S ANDROGRAPHOLIDE X X X Chinese herbal medicine; anti-inflamm; immune boosting?; anti-cancer vs HL60, MCF7, others through G0/G1 block and apoptosis induction P Anisomycin X X protein synthesis inh thru peptidyl transferase of 80S ribosome; treatment activates p54, MAPK, SAPK P #Antimycin A X X X antifungal, antimicrobial; blocks e-transport between cytochrome B and cytochrome C; bind the BH3 domain of Bcl- xL and induce apoptosis in cells overexpressing Bcl-2 and Bcl-xL P !Avermectin B1 X antiworm/insecticide P Azaguanine-8 X X X purine analog S BENZALKONIUM CHLORIDE X X cationic detergent; v common antiseptic and preservative P +Benzethonium chloride X X topical antimicrobial used in cosmetics as preservative S +BENZALKONIUM CHLORIDE X X S !BEPRIDIL HYDROCHLORIDE X X X nonselective Ca channel blocker used for treatment of chronic angina pectoris; alters potential dep and receptor-operated Ca channels and inhibits fast Na inward currents S beta-PELTATIN X X X extracted from Mayapple rhizome (like podophyllotoxin); some evidence of in vitro anti- tumor f/x but vague L Brefeldin A from Penicillium X X fungal metabolite that brefeldianum disrupts Golgi structure and function L Calmidazolium chloride X X Potent inhibitor of calmodulin activation of phosphodiesterase; strongly inhibits calmodulin-dependent Ca2+-ATPase S CAMPTOTHECIN X X L Camptothecin (S.+) X X topo 1 inh P Camptothecine (S.+) X X X P Cephaeline dihydrochloride heptahydrate X X ipecac alkaloid S CETRIMONIUM BROMIDE X X cationic detergent; quaternary ammonium compound used in hair conditioner and as a antimicrobial; tested as a lavage during colon resections...no benefit and potentially toxic S CETYLPYRIDINIUM CHLORIDE X X active ingredient in Scope; antiseptic used in oral rinses L CGP-74514A hydrochloride X X X Cdk1 inh L Chelerythrine chloride X X X PKC inhibitor; affects translocation of PKC from cytosol to plasma membrane S CHELIDONINE (+) X X G2/M arrest associated with increased cycB1 levels, cdc2 activity and SAPK/JNK activity; weak tubulin interaction; induced apoptosis at 1uM in Jurkat cells S CHOLESTAN-3beta.5alpha.6beta- X X X Cholesterol oxidation TRIOL product; cytotoxic due to oxidative stress or cytoskeleton disruption P Ciclopirox ethanolamine X X topical antifungal, anti- inflammatory S CICLOPIROX OLAMINE X X X P Clofazimine X X X leprosy treatment; anti- inflammatory f/x; disrupts cc by binding DNA, may bind K+ transporters S COLCHICEINE X X metabolite of colchicine; less toxic to hepatocytes; less binding to tubulin but presumably has similar modeof action L Colchicine X X binds tubulin/blocks mitosis by preventing spindle formation; bioactive doses would be toxic P Colchicine X X X S COLCHICINE S #CONVALLATOXIN X X X derived from lily of the valley; digitalis-like action S CRASSIN ACETATE X X X antineoplastic vs P388 leukemia and HT29 colon cancer cells in vitro; extracted from marine invertebrates S CRINAMINE X X X P Cycloheximide X X protein synthesis inh S CYCLOHEXIMIDE S CYMARIN X S CYTARABINE X Ara-C; DNA damage, S- phase block; inh DNA/ RNA pol L Cytosine-1-beta-D-arabinofuranoside X X Ara-C; selective inh of hydrochloride DNA synthesis S DACTINOMYCIN X X P Daunorubicin hydrochloride X X DNA intercalator; neuroblastoma treatment S DEOXYSAPPANONE B 7.3′- X X flavanoid derived from DIMETHYL ETHER Caesalpinia sappan tree; Chinese med treatment for tumor, diarrhea; aldose reductase inhibitor?; one study suggesting activity vs head and neck cancer cell line L Dequalinium analog. C-14 linker X X X Protein kinase C-alpha (PKC-alpha) inhibitor P !Dequalinium dichloride X X X Selective blocker of apamin-sensitive K+ channels L !Dequalinium dichloride X X X Member of delocalized lipophilic cations (DLCs), a family of compounds that accumulate in mitochondria driven by the negative transmembrane potential; inhibitor of NADH- ubiquinone reductase; A novel mitochondria delivery system is based on dequalinium. This DLC forms liposome- like aggregates termed ‘DQAsomes’. DQAsomes are being tested as mitochondria drug delivery systems for small molecules such as paclitaxel P #Digitoxigenin X X Digitalis derivative; blocks Na+/K+ pump S #DIGITOXIN P #Digoxigenin X X Digitalis derivative; blocks Na+/K+ pump P #Digoxin X X X Digitalis derivative; blocks Na+/K+ pump S #DIGOXIN X X S DIHYDROGAMBOGIC ACID X X X L !Dihydroouabain X X X Na+/K+ pump inhibitor L Diphenyleneiodonium chloride X X X eNOS inh (endothelial NOS) S DISULFIRAM X X P Disulfiram X X antabuse, rxn with alcohol use L DL-Stearoylcarnitine chloride X X X PKC inh P Doxorubicin hydrochloride X X DNA synthesis inh; stabilizes topo II complex after strand cleavage S EMETINE X X P Emetine dihydrochloride X X ipecac alkaloid; inh protein synthesis by blocking Rb movement on mRNA; inhibit DNA replication in S phase L Emetine dihydrochloride hydrate X X Apoptosis inducer; RNA-Protein translation inhibitor S ERYSOLIN X X X organic isothiocyanate found in cruciferous veggies; increases accumulation of chemo drugs in PANC-1, MCF- 7, NCI-H460 cell lines P Etoposide X X X topo II inh L Etoposide X X P Fosfosal salicylic acid derivative/ anti-inflammatory S GAMBOGIC ACID X X X principle pigment of gambage resin (bright orange); caspase activator (not well characterized); growth/ tumor inhibitory vs HeLa, HEL, gastic cancer, lung carcinoma cell lines S GENTIAN VIOLET X X L Idarubicin X X X antineoplastic, DNA metabolism S !IMIDACLOPRIDE X X X a4b2 nAChR agonist; activates ERK pathway; insecticide S JUGLONE X X X Pin1 inh; alkylates thioredoxin reductase; PI3K inh?; inhibits growth of HCT-15, HeLa, HL60 cell lines P Kaempferol antioxidant/flavenoid P #Lanatoside C X X Digitalis derivative; blocks Na+/K+ pump S #LANATOSIDE C X X S LIMONIN X X X isolated from citrus fruit seeds; inhibits HIV1 protease activity; antinociceptive, inhibits MCF7 growth but not other cancer cell lines L *Loratadine X X X H1 Histamine R antagonist S LYCORINE X X P +Mebendazole anthelmintic; blocks glucose/nutrient uptake in adult worm intestine; reported to be a mitotic spindle poison (resulting in chromosomal nondisjunction) S MECHLORETHAMINE X X X mustard gas derivative; polyfunctional alkylating agent = DNA breaks and crosslinks; non cc phase specific S *MECLIZINE HYDROCHLORIDE X X X antivert/bonine; motion sickness/vertigo treatment; piperazine class of antihistamines L Melphalan Antineoplastic; forms DNA intrastrand crosslinks by bifunctional alkylation in 5′-GGC sequences; used in NB megatherapy P Menadione vitamin K3 (vitK2 precursor); reacts with — SH/soaks up GSH = high ROS = altered Ca2+ = Ca- dep DNA fragmentation; toxic at high doses so vitK2 currently being used in cancer trials P +Methiazole anthelmintic P +Methyl benzethonium X X topical antimicrobial S +METHYLBENZETHONIUM X X CHLORIDE L !MG 624 X X X Nicotinic acetylcholine receptor antagonist; selectively inhibits alpha-bungarotoxin sensitive receptors that contain the alpha7 subunit S MITOMYCIN C X X X S MITOXANTHRONE X HYDROCHLORIDE L Mitoxantrone X X topo II inh; used in ALL, breast cancer, non- hodgkin's lymphoma P Mitoxantrone dihydrochloride X X P Mycophenolic acid X X X immunosuppressant; blocks de novo purine biosynthesis S NERIIFOLIN L #Ouabain X X Blocks movement of the H5 and H6 transmembrane domains of Na+-K+ ATPases S #OUABAIN X X X S +OXYBENDAZOLE X X X benzimidazole anthelmintic used in horses and other ruminants S OXYPHENBUTAZONE X X Anti-inflammatory (Tandearil); binds phospholipase A2, human neutrophil elastase P Paclitaxel X X X taxol S PACLITAXEL X X taxol S PARAROSANILINE PAMOATE X X X P Parthenolide X X X feverfew extract; NFkB inh, p53 activ, increased ROS, JNK activ (indep of NFkB and ROS), inh of MAPK/ERK pathway S PARTHENOLIDE X X seems to work best as a chemosensitizer...studies in breast, skin, pancreatic, thoracic cell lines S PATULIN X X S #PERIPLOCYMARIN X X X digoxin relative S #PERUVOSIDE X X X inhibitor of Na+K+- ATPase; cardiac glycoside class S PHENYLMERCURIC ACETATE X X P Podophyllotoxin X X X etoposide precursor/ Antineoplastic glucoside; inhibitor of microtubule assembly; G2/M cc arrest L Podophyllotoxin X X S PODOPHYLLOTOXIN ACETATE X X P !Primaquine diphosphate X X X antimalarial/inh of DNA, RNA, protein synthesis/muscarinic AChR inh P #Proscillaridin A X X Na+/K+ ATPase inh; digitalis related P Puromycin dihydrochloride X X protein synthesis inh, premature strand termination S PUROMYCIN HYDROCHLORIDE X X S PYRITHIONE ZINC X X X S PYRROMYCIN X X anthracycline derivative; monosaccharide; induces erythroid diff in K562 P +Pyrvinium pamoate pinworm treatment; prevents gluccose uptake; antitumor activity vs pancreatic cell line in SCID model, see decrease Akt phos L !Quinacrine dihydrochloride X X X Monoamine oxidase (MAO) inhibitor; antimalarial P !Quinacrine dihydrochloride dihydrate X X Antimalarial, causes female sterility S RETUSOQUINONE X X ? P !Sanguinarine X X Inhibitor of Mg2+ and Na+/K+-ATPase; isolated from the leaves and stems of Macleaya cordata and microcarpa L !Sanguinarine chloride X X X S !SANGUINARINE SULFATE X X S SARMENTOGENIN X X P !Scoulerine X X X opium intermediate/ alkaloid; a1- adrenoreceptor inh (G- protein coupled R found on PNS sympathetic nerve terminals, CNS postsynaptically; target of catecholamines) P !Strophanthidin X X X blocks Na+/K+ ATPase at high conc; opposite f/x at low dose (Quabain) S !STROPHANTHIDIN X X S !STROPHANTHIDINIC ACID X X !LACTONE ACETATE P !Strophantine octahydrate X X L Taxol X X Antitumor agent; promotes assembly of microtubules and inhibits tubulin disassembly process S TENIPOSIDE X X X common NB treatment; semisynthetic podophyllotoxin derivative related to etoposide; topo II inh; induced single strand DNA breaks; activity in late S and G2 phases P *Terfenadine X X X nonsedating antihistimineoff market due to cardiac f/x S THIMEROSAL X X S THIRAM P Thonzonium bromide X X cationic detergent S TOMATINE X X X P Verteporfin photoreactive dye used in treatment of macular generation; anti- angiogenic S VINBLASTINE SULFATE X X L Vinblastine sulfate salt X X X Inhibitor of microtubule assembly L Vincristine sulfate X X X Inhibitor of microtubule assembly 132/151 repeated (87%) BOLD: DNA damage/protein synthesis inhibitor/cell cycle block italics: protein inhibitor/activator *antihistamine #digoxin derivative +metabolic f/x !ion channel inhibitor/neuro R inhibitor

Example 5 Selected Compounds of Interest

The present example demonstrates the utility of the present invention for providing a composition suitable for the inhibition of neuroblastoma, and for the treatment of neuroblastoma.

Forty-seven (47) compounds were selected based on differential cell toxicity and compound mechanism of action. Forty are novel compounds for the treatment of neuroblastoma. None of these 40 compounds have been used clinically in neuroblastoma therapy nor have they been examined in clinical trials. Seven compounds have been previously used for neuroblastoma treatment (marked with asterisk), and serve as positive controls in the selection and screening process of new chemical entities that may be used in the treatment of neuroblastoma according the present invention.

TABLE 17 NB12 IC50 Compounds of Interest: (nM) Notes: 2.3-Dimethoxy-1.4- nd ROS modulator/Redox cycling agent used naphthoquinone to study role of ROS AKLAVINE 778.5 natural product; anti-infective; related HYDROCHLORIDE structures have broad activity against NIH tumor lines Amodiaquin dihydrochloride 790 antimalarial; treatment of CNS degeneration dihydrate (Alzheimer, MS); 4-aminoquinoline family; narrow therapeutic/toxic window in children; 4-Aminoquinolines depress cardiac muscle, impair cardiac conductivity, and produce vasodilatation with resultant hypotension AMSACRINE 1214 topo II inh; used in AML; may also be active HYDROCHLORIDE vs malaria *ANCITABINE 519.7 cyclocytidine HCl; DNA-synthesis inhibitor HYDROCHLORIDE (cytosine analog); antileukemic Azaguanine-8 331 purine analog beta-PELTATIN 1949 extracted from Mayapple rhizome (like podophyllotoxin); some evidence of in vitro anti-tumor f/x but vague Camptothecine (S.+) 183.3 topoisomerase 1 inh CGP-74514A hydrochloride Cdk1 inh Chelerythrine chloride 2553 PKC inhibitor; affects translocation of PKC from cytosol to plasma membrane CHOLESTAN- 2410 Cholesterol oxidation product; cytotoxic due 3beta.5alpha.6beta-TRIOL to oxidative stress or cytoskeleton disruption CICLOPIROX OLAMINE 2048 topical antifungal, anti-inflammatory via inhibition of 5-lipoxygenase and cyclo- oxygenase; hydroxypyridone family; Loprox Clofazimine 1417 leprosy treatment; anti-inflammatory f/x; disrupts cc by binding DNA, may bind K+ transporters Colchicine 29.3 binds tubulin/blocks mitosis by preventing spindle formation; bioactive doses would probably be toxic CONVALLATOXIN 73.17 derived from lily of the valley; digitalis-like action CRASSIN ACETATE 1947 antineoplastic vs P388 leukemia and HT29 colon cancer cells in vitro; cembranolides (14-member ring diterpenoid lactones) derived from Caribbean gorgonians (marine invertebrates) CRINAMINE 1735 HIF-1alpha inhibitor; affinity to the serotonin reuptake transport protein Dequalinium analog. C-14 linker 1112 Protein kinase C-alpha (PKC-alpha) inhibitor Dequalinium dichloride 3617 Selective blocker of apamin-sensitive K+ channels; mitochondria toxicity Digitoxin nd Na+/K+ pump inhibitor Digoxigenin nd Na+/K+ pump inhibitor Digoxin 542.2 Digitalis derivative; blocks Na+/K+ pump DIHYDROGAMBOGIC ACID 1687 Dihydroouabain 1540 Na+/K+ pump inhibitor ERYSOLIN 3276 organic isothiocyanate found in cruciferous veggies; increases accumulation of chemo drugs in PANC-1, MCF-7, NCI-H460 cell lines *Etoposide 693.7 topoisomerase II inh GAMBOGIC ACID 1695 principle pigment of gambage resin (bright orange); caspase activator (not well characterized); growth/tumor inhibitory vs HeLa, HEL, gastic cancer, lung carcinoma cell lines *Idarubicin 203.7 antineoplastic, DNA metabolism MECHLORETHAMINE 438.2 mustard gas derivative; polyfunctional alkylating agent = DNA breaks and crosslinks; non cell cycle phase specific MECLIZINE 2537 “antivert/bonine”; motion sickness/vertigo HYDROCHLORIDE treatment; piperazine class of antihistamines MG 624 848 Nicotinic acetylcholine receptor antagonist; selectively inhibits alpha-bungarotoxin sensitive receptors that contain the alpha7 subunit MITOXANTHRONE 60.46 topo II inh; used in ALL, breast cancer, non- HYDROCHLORIDE hodgkin's lymphoma OUABAIN 122.6 Blocks movement of the H5 and H6 transmembrane domains of Na+-K+ ATPases OXYBENDAZOLE nd benzimidazole anthelmintic used in horses and other ruminants Paclitaxel nd aka taxol; Antitumor agent; promotes assembly of microtubules and inhibits tubulin disassembly process Parthenolide 2261 feverfew extract; NFkB inh, p53 activ, increased ROS, JNK activ (indep of NFkB and ROS), inh of MAPK/ERK pathway; seems to work best as a chemosensitizer...studies in breast, skin, pancreatic, thoracic cell lines PATULIN nd polyketide lactone, produced by certain fungal species of Penicillium, Aspergillus and Byssochlamys growing on fruit, including apples, pears, grapes; crosslinks DNA, causes p38 and JNK phosphorylation in HEK cells PERIPLOCYMARIN 2703 digoxin relative PERUVOSIDE 222.5 inhibitor of Na+K+-ATPase; cardiac glycoside class *Podophyllotoxin 135 etoposide precursor/Antineoplastic glucoside; inhibitor of microtubule assembly; G2/M cc arrest Primaquine diphosphate nd antimalarial/inh of DNA, RNA, protein synthesis/muscarinic AChR inh Quinacrine dihydrochloride 2556 Monoamine oxidase (MAO) inhibitor; antimalarial Sanguinarine chloride 1795 Inhibitor of Mg2+ and Na+/K+-ATPase; isolated from the leaves and stems of Macleaya cordata and microcarpa *TENIPOSIDE 705.5 common NB treatment; semisynthetic podophyllotoxin derivative related to etoposide; topo II inh; induced single strand DNA breaks; activity in late S and G2 phases TOMATINE nd alkaloid found in leaves of tomato and unripe fruit; tetrasaccharide tomato glycoalkaloid alpha-tomatine, trisaccharide beta(1)-tomatine, disaccharide gamma- tomatine, monosaccharide delta-tomatine, and their common aglycon tomatidine; inhibit the growth of human colon (HT29) and liver (HepG2) cancer cells *Vinblastine sulfate salt 113 Inhibitor of microtubule assembly *Vincristine sulfate 61.95 Inhibitor of microtubule assembly

Example 6 Reduced Cytotoxicity to Non-Neuroblastoma Cells

The standard of care for poor prognosis neuroblastoma tumors is intensive induction chemotherapy with cisplatin, etoposide, cyclophosphamide, and doxorubicin, high-dose myeloablative therapy with bone marrow transplant, surgery, radiation therapy, and biologic or maintenance therapy to eradicate minimal residual disease. The chemotherapy regimen is designed to induce massive genomic damage and subsequent cell death in proliferating cells. This strategy results in the death of both tumor and normal cells and is extremely debilitating to young patients. Additionally, this strategy does not target the tumor-initiating cells (TICs). The survival of NB TICs may contribute to tumor relapse.

The compounds identified in the present invention target cellular pathways specific to neuroblastoma tumor-initiating cells while having little or no effect on normal cells (FIG. 5). Therefore, the compositions and pharmaceutical preparations of the present invention will provide a treatment method for neuroblastoma having fewer and/or less intense or pronounced toxic side effects in patients.

All documents, patents, journal articles and other materials cited in the present application are hereby incorporated by reference.

Although the present invention has been fully described in conjunction with several embodiments thereof with reference to the accompanying drawings, it is to be understood that various changes and modifications may be apparent to those skilled in the art. Such changes and modifications are to be understood as included within the scope of the present invention as defined by the appended claims, unless they depart therefrom.

BIBLIOGRAPHY

The references listed below as well as the references cited throughout the specification are incorporated herein by reference to the extent that they supplement, explain, provide a background for or teach methodology, techniques and/or compositions employed herein.

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1-7. (canceled)
 8. A method comprising the following steps: (a) providing neuroblastoma tumor-initiating cells; and (b) administering an effective amount of a composition comprising a chemical entity that selectively targets neuroblastoma tumor-initiating cells to said neuroblastoma tumor-initiating cells.
 9. The method of claim 8 wherein said chemical entity is selected from the following: 10-Hydroxycamtothecin; 2,3-Dimethoxy-1,4-naphthoquinone; 4′-Demethylepipodophyllotoxin; Amsacrine Hydrochloride; Andrographolide; Antimycin A; Azaguanine-8; Benzalkonium chloride; Benzethonium chloride; Bepridil hydrochloride; beta-peltatin; Camptothecine (S.+); Cetylpyridinium chloride; Chelerythrine chloride; Cholestan-3beta.5alpha.6beta-Triol; Ciclopirox Ethanolamine; Ciclopirox Olamine; Clofazimine; Convallatoxin; Crassin Acetate; Crinamine; Cycloheximide; Cytosine-1-beta-D-arabinofuranoside hydrochloride; Dequalinium analog. C-14 linker; Dequalinium dichloride; Digoxigenin; DL-Stearoylcarnitine chloride; Erysolin; Gambogic acid; Imidaclopride; Limonin; Loratadine; Mechlorethamine; Meclizine hydrochloride; MG 624; Mycophenolic acid; Oxybendazole; Paclitaxel; Pararosaniline pamoate; Parthenolide; Podophyllotoxin; Primaquine diphosphate; Scoulerine; Taxol; Teniposide; or Vinblastine sulfate
 10. (canceled)
 11. The method of claim 8 wherein the composition further comprises ancitabine hydrochloride, doxorubicin hydrochloride, etoposide, or vincristine sulfate.
 12. The method of claim 8 wherein the neuroblastoma tumor-initiating cells are derived from an animal having neuroblastoma.
 13. The method of claim 8 wherein the composition has a reduced non-neuroblastoma tumor-initiating cell cytotoxicity.
 14. The method of claim 8 wherein the composition is essentially free of non-neuroblastoma tumor cell inhibiting activity.
 15. A method comprising the following steps: (a) identifying an animal having neuroblastoma; and (b) administering to said animal a composition comprising an effective amount of a chemical entity that selectively targets neuroblastoma tumor-initiating cells.
 16. The method of claim 15 wherein said chemical entity is selected from the following: 10-Hydroxycamtothecin; 2,3-Dimethoxy-1,4-naphthoquinone; 4′-Demethylepipodophyllotoxin; Amsacrine Hydrochloride; Andrographolide; Antimycin A; Azaguanine-8; Benzalkonium chloride; Benzethonium chloride; Bepridil hydrochloride; beta-peltatin; Camptothecine (S.+); Cetylpyridinium chloride; Chelerythrine chloride; Cholestan-3beta.5alpha.6beta-Triol; Ciclopirox Ethanolamine; Ciclopirox Olamine; Clofazimine; Convallatoxin; Crassin Acetate; Crinamine; Cycloheximide; Cytosine-1-beta-D-arabinofuranoside hydrochloride; Dequalinium analog. C-14 linker; Dequalinium dichloride; Digoxigenin; DL-Stearoylcarnitine chloride; Erysolin; Gambogic acid; Imidaclopride; Limonin; Loratadine; Mechlorethamine; Meclizine hydrochloride; MG 624; Mycophenolic acid; Oxybendazole; Paclitaxel; Pararosaniline pamoate; Parthenolide; Podophyllotoxin; Primaquine diphosphate; Scoulerine; Taxol; Teniposide; or Vinblastine sulfate
 17. The method of claim 15 wherein the composition further comprises ancitabine hydrochloride, doxorubicin hydrochloride, etoposide, or vincristine sulfate.
 18. The method of claim 15 wherein the animal is a human of 12 years of age or younger.
 19. The method of claim 15 wherein the composition is essentially free of non-neuroblastoma tumor-initiating cell inhibiting activity.
 20. (canceled) 